Summary of Steps

1. Obtain baseline view of the sonoanatomy of the patient’s airway prior to intubation 
   • ​​Place the high frequency linear probe above the patient’s suprasternal notch in the transverse plane​ 
   • Identify the trachea, thyroid cartilage, esophagus
2. Choose between static ​and​​ dynamic technique for Airway POCUS ​
   • Static: intubate and repeat the ultrasound​.​​ Identify ​the double tract sign if present
   • Dynamic: keep the probe ​​position​ed in the suprasternal notch​​.​​  Watch ​for the snowstorm​ (motion artifact), bullet (spreading of the vocal cords)​ and double trachea ​signs​.
3. Assess for the depth of the ETT 
   • Evaluate lung sliding
   • Evaluate ​saline filled ​cuff placement 
4. If urgent cricothyroidotomy is required, consider ultrasound identification of the cricothyroid membrane

 

Summary

• POCUS has shown to be a fast, effective and safe adjunct to other ETT position confirmatory methods  

• To confirm ETT placement, the technique can be performed dynamically or statically using a high frequency linear probe placed in the transverse plane at the level of the suprasternal notch 

• With endotracheal intubation, the esophagus should be collapsed​.​​  Only​​ one air filled structure should be seen (trachea) and the snowstorm sign can be seen dynamically. 

• With ​esophageal intubation, the double tract (double trachea sign) will be seen 

• To confirm ETT placement, ultrasound can be used to assess lung sliding, ​and ​cuff placement​.​ ​     ​ 

• Ultrasound can be used to identify the location of the cricothyroid membrane​ to facilitate surgical airway management.​